title: Adenosquamous lung carcinomas: a histologic subtype with poor prognosis.
abstract: BACKGROUND
  The aim of this study is to evaluate the prognostic factors and outcome of patients operated for adenosquamous (ADS) carcinoma of the lung, in comparison with adenocarcinoma (AD) and squamous cell carcinoma (SCC).
  
  
  METHODS
  a retrospective review of our thoracic cancer surgical database for patients operated for ADS, SCC and AD between January, 1995 and December, 2009 was done.
  
  
  RESULTS
  Forty-eight patients (39 males, 81.3%) had ADS; complete tumor resection and lymphadenectomy was accomplished in all patients. A higher stage at presentation was observed in ADS, as compared to AD or SCC (p=0.0001). Three and 5-year survival rates were 25% and 15%. ADS overall survival was worse than AD or SCC (p=0.0005). Three and 5-year survival rates of ADS Stage I were similar to those of Stage IIIA AD or SCC. More than half ADS patients developed distant metastases (MTS) or local recurrences. Brain MTS were the most frequent. Median survival for those patients was 8±2.3 months. Postoperative platinum-based chemotherapy statistically improved patients survival (p=0.02). In the multivariate analysis, the presence of MTS (p=0.001), the tumor perineural invasion (p=0.01) and the tumor stage (p=0.0005) were factors associated with poor prognosis. Adjuvant chemotherapy was a significant positive prognostic factor (p=0.00001).
  
  
  CONCLUSIONS
  ADS are uncommon and extremely aggressive lung tumors. Adjuvant chemotherapy should be administered even in Stage I radically resected tumors. A whole brain postoperative prophylactic radiotherapy could be proposed to reduce risk of developing brain MTS.
authors.affiliation: University of Torino Italy, Department of Thoracic Surgery, Via Genova, 3 10126 Torino, Italy. pierluigi.filosso@unito.it
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.forename: Sofia
authors.initials: S
authors.lastname: Asioli
authors.forename: Roberto
authors.initials: R
authors.lastname: Giobbe
authors.forename: Luigia
authors.initials: L
authors.lastname: Macri
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Bruna
authors.forename: Alberto
authors.initials: A
authors.lastname: Sandri
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000556:secondary / Q000628:therapy; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000294:innervation / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis